H Moving to a hospital or skilled nursing facility What to expect when you have MRSA (Methicillin-resistant Staphylococcus aureus) A booklet for patients, residents, family members, and caregivers
About this booklet You are getting this booklet because you are moving between a hospital and a skilled nursing facility. Hospitals and skilled nursing facilities care for you at different stages of your illness or injury. Because of this, they don t always do things the same way. This booklet will explain the differences between them, and what you can expect during your stay. This booklet was developed with help from residents, family members, caregivers, and staff from hospitals and skilled nursing facilities. What we mean by skilled nursing facility Facilities with a registered nurse available in the building at least 16 out of every 24 hours, such as: Nursing homes Rehabilitation centers
Contents Why am I being moved to a hospital or skilled nursing facility?...1 What is MRSA?...2 Prevention How do hospitals and skilled nursing facilities prevent the spread of MRSA?...3 What is the best way to wash hands?...4 How can I prevent the spread of MRSA?...5 How can family and friends prevent the spread of MRSA?...6 What if family and friends have questions?...7 Your care How am I cared for if I have an active MRSA infection?...8 How am I cared for if I am a carrier?...9 How is MRSA treated?...10 Will I have a roommate?...11 Housekeeping Does my room need extra cleaning?...12 How will my dishes be done?...13 What happens with my laundry?...14 What if my family takes my laundry home to wash?...15 Resources...16 Acknowledgments...16 H
Why am I being moved to a hospital or skilled nursing facility? To understand why you are being moved, it is helpful to know the differences between hospitals and skilled nursing facilities. HOSPITALS are for people who are very sick. Someone getting care at a hospital is called a patient. A patient usually stays at a hospital for only a short period of time. You may go to a hospital if you suddenly get very sick, if your life is in danger, or if you need special care that a skilled nursing facility can t give you. H SKILLED NURSING FACILITIES are for people who can t safely take care of themselves at home. Someone getting care at a skilled nursing facility is called a resident. A resident may stay at a skilled nursing facility for weeks, months, or years. Some residents consider the skilled nursing facility their home, so it may seem more casual than a hospital. You may be moved to a skilled nursing facility if you are healing from an illness or injury, if you need special care, or if you can t safely take care of yourself at home. 1
What is MRSA? MRSA is a type of staphylococcus or staph bacteria that can t be killed by common antibiotics. This type of bacteria is called antibiotic resistant bacteria. Many people have staph bacteria on their skin that don t cause any harm. However, sometimes these bacteria can get inside the body through a break in the skin and cause an infection. If this infection is caused by antibiotic resistant bacteria, then it is more difficult to treat. MRSA is just one type of antibiotic resistant bacteria. This booklet focuses on MRSA because that is the type of antibiotic resistant bacteria that most people have heard about. However, information in this booklet may also apply to other types of antibiotic resistant bacteria. There are two ways that you can have MRSA: You can have an active infection. This means that the MRSA bacteria are either on your body or in your body and they are causing an infection. You can have an infection on your skin, in your digestive system, in your lungs, or in other parts of your body. If you have an active MRSA infection, it can easily be spread to other people. Any contact with your infection, with fluid from your infection (mucus, blood, urine, etc.), or with something that has touched your infection (like a towel) could spread MRSA. You can be a carrier. This means that the MRSA bacteria are either on your body or in your body, but they are not causing an infection. If you are a carrier of MRSA, you can still have the bacteria on your skin and spread MRSA to other people. If you don t wash your hands properly, you can spread MRSA to things that you touch with your hands. MRSA can also be found in the fluid that comes out of your mouth and nose when you cough or sneeze. It s important to cover your mouth and nose with a tissue or your arm when you cough or sneeze. 2
How do hospitals and skilled nursing facilities prevent the spread of MRSA? Everyone who enters a hospital or skilled nursing facility must follow certain rules to prevent the spread of any bacteria. These rules are called standard precautions. These rules apply to everyone people who have MRSA and people who don t have MRSA. What are standard precautions? Standard precautions mean that... Everyone must: Wash hands when entering and leaving a room. Wash hands before and after touching patients, residents, or roommates. Wash hands after using the bathroom. Cover mouth and nose with a tissue or arm when sneezing or coughing, wash hands afterwards, and throw away used tissues immediately. Doctors and staff must follow all of the above and ALSO: Wear gloves when touching body fluids. Wear a gown if body fluids could get on the clothes. Wear a mask and eye protection (goggles or shield) if body fluids could get in the eyes or on the face. Wear a mask and eye protection (goggles or shield) if patients or residents are coughing. Clean and disinfect equipment that is shared between patients or residents. Disposable equipment may also be used. 3
When someone is contagious, hospitals and skilled nursing facilities will put even stricter rules in place. These rules are called contact precautions. Contact precautions are used along with standard precautions. What are contact precautions? Contact precautions mean that... Doctors and staff must: Always wear a gown and gloves when caring for patients or residents these are put on before entering the room, and taken off before leaving the room. Clean and disinfect equipment that is shared between patients or residents. Disposable equipment may also be used. What is the best way to wash hands? Regular hand washing is the best way to prevent the spread of bacteria. Wash hands with soap and water, or use a hand sanitizer with at least 60 percent alcohol. Use hand sanitizers only when hands are not visibly dirty. This is the hand washing method recommended by health care providers: Wet your hands first under warm running water. Apply soap and rub hands together for at least 15 seconds, getting between the fingers and around nails. Rinse with warm running water. Dry hands with a paper towel. Turn the faucet off using a paper towel (remember, your hands were dirty when you turned the faucet on). Throw the paper towel in the trash. 4
How can I prevent the spread of MRSA? Wash hands when entering and leaving a room. Wash hands before and after touching patients, residents, or roommates. Wash hands after using the bathroom. Wash hands before and after touching your eyes, nose, mouth, genitals, pimples, boils, sores, or rashes. If you cough or sneeze, cover your mouth and nose with a tissue or your arm. Throw away used tissue immediately, and wash your hands right away. Don t use cloth handkerchiefs. Don t share towels, razors, toothbrushes, bar soap, or other personal items. Remind doctors, staff, and family members to wash their hands before and after caring for you. Remind family and friends to wash their hands when entering and leaving your room, and before and after touching you. Don t touch other people s cuts, sores, or rashes unless you are wearing gloves. If you see someone not following standard or contact precautions, please say something. This includes doctors, staff, friends, family [members, or other patients or residents. [ 5
How can family and friends prevent the spread of MRSA? Visits from family and friends are important for your health and healing. There are steps that your visitors can take to help protect you and themselves. H HOSPITALS Regular hand washing is the most important thing your family and friends can do. This is especially important when they enter and leave your room, and before and after they touch you. If you are coughing, your family and friends should wear a mask. Standard precautions must be followed by everyone at all times (see page 3). Some hospitals may post a sign on your door explaining standard precautions. Remind your family and friends to follow the instructions on this sign. If you are on contact precautions, a sign will be posted on your door about what to do. Remind your family and friends to follow the instructions on this sign. SKILLED NURSING FACILITIES Regular hand washing is the most important thing your family and friends can do. This is especially important when they enter and leave your room, and before and after they touch you. If you are coughing, your family and friends should wear a mask. There may be a sign on your door asking visitors to go to the nursing desk for instructions on how to best protect themselves and you. Remind your family and friends to do this. 6
What if family and friends have questions? H HOSPITALS First have families and friends talk to your doctor or the nurse caring for you. If they want more information, they can ask to talk with the infection preventionist. There is one at every hospital. You can also suggest that they read the Living with MRSA booklet. It is available online at: http://here.doh.wa.gov/materials/living-with-mrsa SKILLED NURSING FACILITIES First have families and friends talk to the nurse caring for you. If they want more information, they can ask to talk with the infection control nurse. There is one at every skilled nursing facility. You can also suggest that they read the Living with MRSA booklet. It is available online at: http://here.doh.wa.gov/materials/living-with-mrsa Living with MRSA This is really serious. I need to do something about this now! Learning how to control the spread of Methicillin-Resistant Staphylococcus Aureus (MRSA) 7
How am I cared for if I have an active MRSA infection? H HOSPITALS Standard precautions and contact precautions are followed by everyone who takes care of you (see pages 3 4). You are only allowed to leave your room for very urgent reasons, like tests or surgery. Before you leave your room, you must wash your hands and put on a clean gown or robe. If you are coughing, you must wear a mask. Staff will also make sure your infection is contained. Any equipment that you are using, such as a walker or wheelchair, is cleaned before you leave your room. SKILLED NURSING FACILITIES Standard precautions are followed by everyone who takes care of you (see page 3). Contact precautions are followed if your infection can t be contained, or if you need help with daily tasks like using the bathroom or bathing (see page 4). This means that before you leave your room, you must: Wash your hands. Make sure your clothes are clean. Make sure your infection is contained. Wear a mask if you are coughing. Any equipment that you are using, such as a walker or wheelchair, is cleaned before you leave your room. 8
How am I cared for if I am a carrier? H HOSPITALS The skilled nursing facility where you were staying tells the hospital staff that you are a carrier. Both standard precautions and contact precautions are followed by everyone who takes care of you (see pages 3 4). You are only allowed to leave your room for very urgent reasons, like tests or surgery. If you are at the hospital to have surgery, your doctor may have you bathe with special soap or may put antibiotic ointment in your nose. These things can help stop the MRSA bacteria from getting inside your body. SKILLED NURSING FACILITIES Standard precautions are followed by everyone who takes care of you (see page 3). Contact precautions are usually not used at skilled nursing facilities if you are a carrier. This is because most residents are not as sick as people in hospitals. If you see someone not following standard or contact precautions, please say something. This includes doctors, staff, visitors, family [members, other patients, or residents. [ 9
How is MRSA treated? MRSA is treatable. Treatment should always be done by your health care provider. It is important to follow any instructions for treatment that your health care provider gives you. If you are a carrier and you DO NOT have an active MRSA infection: Your health care provider may do tests to find out if you still carry MRSA bacteria on your skin. If you are a MRSA carrier, your health care provider may decide to: Do nothing, because the bacteria may go away without treatment. Try to reduce the amount of bacteria on your skin by using a special soap. If you have an active MRSA infection: Your health care provider may choose one or more of the following treatments: Drain the infection. Give you antibiotics. Try to reduce the amount of bacteria on your skin by using a special soap. 10
Will I have a roommate? H HOSPITALS If you have an active MRSA infection or if you are a carrier: Every effort is made to give you a private room. If no private rooms are available, then you may share a room with someone who also has MRSA this is called cohorting. If this isn t possible, then you may share a room with someone who is at low risk of getting an infection. SKILLED NURSING FACILITIES If you have an active MRSA infection or if you are a carrier: Most likely you will share a room with someone who also has MRSA this is called cohorting. If this isn t possible, then you may share a room with someone who is at low risk of getting an infection. 11
Does my room need extra cleaning? H HOSPITALS No. Your room is cleaned the same way as other rooms. All rooms are cleaned well and on a regular schedule. Special attention is given to items that are touched a lot like the call light, telephone, television remote control, grab bars, bed rails, and door knobs. The mop and the cleaning solution that are used in your room are only used there. The mop and the solution in the bucket are changed before being used in the next room. This helps prevent the spread of MRSA. SKILLED NURSING FACILITIES No. Your room is cleaned the same way as other rooms. All rooms are cleaned well and on a regular schedule. Special attention is given to items that are touched a lot like the call light, telephone, television remote control, grab bars, bed rails, and door knobs. The mop and the cleaning solution that are used in your room are only used there. The mop and the solution in the bucket are changed before being used in the next room. This helps prevent the spread of MRSA. 12
How will my dishes be done? H HOSPITALS Your dishes are done the same way as all other dishes. All dishes, glasses, and trays are cleaned and disinfected by using hot water and detergent and by drying at high temperatures. This process kills MRSA bacteria. You do not need to use paper plates or plastic silverware. SKILLED NURSING FACILITIES Your dishes are done the same way as all other dishes. All dishes, glasses, and trays are cleaned and disinfected by using hot water and detergent and by drying at high temperatures. This process kills MRSA bacteria. You do not need to use paper plates or plastic silverware. 13
What happens with my laundry? H HOSPITALS Your laundry is done the same way as all other laundry. There is a laundry bag or hamper in your room for all used towels, sheets, and hospital gowns. Laundry is cleaned and disinfected by using hot water and detergent and by drying at high temperatures. This process kills MRSA bacteria. SKILLED NURSING FACILITIES Your laundry is done the same way as all other laundry. There is a laundry bag or hamper in your room for all used towels, sheets, and hospital gowns. Laundry is cleaned and disinfected by using hot water and detergent and by drying at high temperatures. This process kills MRSA bacteria. 14
What if my family takes my laundry home to wash? They should follow these steps to prevent the spread of MRSA bacteria. MRSA bacteria is killed by using at least one of the following: Hot water (at least 130 o F) Liquid bleach or laundry soap with dry bleach Hot dryer (at least 160 o F) Before washing Wear disposable gloves to handle laundry that is soiled with body fluids even if the fluids have dried. Hold the laundry away from your body so bacteria doesn t get on your clothes. Put laundry that is soiled with body fluids in a plastic bag, separate from other household laundry, until it is ready to wash. This is to prevent other people from touching it and to remind you to wear gloves when you handle it. Washing laundry When taking laundry that is soiled with body fluids out of the bag, wear gloves and hold the laundry away from your body so bacteria doesn t get on your clothes. It s okay to mix laundry that is soiled with body fluids and other household laundry in the washer. MRSA bacteria is killed by using heat or bleach. Use hot water (at least 130 o F) and laundry soap. OR Use cold water and laundry soap with dry bleach or laundry soap and liquid bleach. Liquid bleach may fade or discolor clothes. Laundry soap with dry bleach will not. Drying laundry Dry clothes all the way in a warm or hot (at least 160 o F) dryer. If you used bleach or laundry soap with dry bleach to wash clothes, then it s okay not to dry clothes in the dryer. 15
Resources For more information: Tacoma-Pierce County Health Department www.tpchd.org (253-798-6500) Washington State Department of Health www.doh.wa.gov (1-800-525-0127) Centers for Disease Control and Prevention www.cdc.gov Acknowledgments Residents, family members, and staff involved in testing this booklet Washington State Department of Health Office of Health Promotion Tacoma-Pierce County Health Department Pierce County Antimicrobial Resistance Task Force Infection Control & Prevention Committee This committee includes representatives from all civilian Pierce County hospitals, several Pierce County long-term care facilities, medical clinics/offices, the Long Term Care Ombudsman Program, and local Department of Social & Health Services offices. Washington State Hospital Association for permission to use the Washington State isolation signs (shown on pages 3, 4, and 6). To download these signs, visit: www.wsha.org/page.cfm?id=0208 For persons with disabilities this document is available on request in other formats. To submit a request, please call 1-800-525-0127 (TTY/TDD 1-800-833-6388). 16
H DOH 130-084 January 2010 ANTIBIOTIC RESISTANCE Task Force